Cor pulmonale is right heart failure caused by chronic pulmonary hypertension. It is often caused by lung diseases like COPD and asthma, or pulmonary vascular diseases like pulmonary embolism. Symptoms include dyspnea, fatigue and syncope. Signs include elevated jugular venous pressure, heart murmurs, hepatomegaly and edema. Investigations show signs of pulmonary hypertension and right heart strain on tests like chest x-ray and ECG. Management focuses on treating the underlying cause, respiratory failure with oxygen, and cardiac failure with diuretics. The prognosis is generally poor with 50% of patients dying within 5 years.

1. Cor pulmonale

2. • Cor pulmonale is right heart failure caused
by chronic pulmonary hypertension

3. Causes of cor pulmonale
• Lung disease
Asthma (severe, chronic)
COPD
Bronchiectasis
Pulmonary fibrosis
Lung resection

4. • Pulmonary vascular disease
Pulmonary emboli
Pulmonary vasculitis
Primary pulmonary hypertension
ARDS
Sickle-cell disease
Parasite infestation

5. • Thoracic cage abnormality
Kyphosis
Scoliosis
Thoracoplasty

6. • Neuromuscular disease
Myasthenia gravis
Poliomyelitis
Motor neurone disease

7. • Hypoventilation
Sleep apnoea
Enlarged adenoids in children
Cerebrovascular disease

8. Clinical features
• Symptoms include dyspnoea, fatigue, or
syncope. Signs: cyanosis; tachycardia;
raised JVP with prominent a and v waves;
RV heave; loud p2, pansystolic murmur
(tricuspid regurgitation); early diastolic
Graham Steell murmur; hepatomegaly
and oedema.

9. Investigations
• FBC: Hb and haematocrit ↑(secondary
polycythaemia). ABG; hypoxia, with or
without hypercapnia. CXR; enlarged right
atrium and ventricle, prominent pulmonary
arteries. ECG; P pulmonale; right axis
deviation; right ventricular hypertrophy/
strain.

10. Management
• Treat underlying cause – e.g. COPD and
pulmonary infections
• Treat respiratory failure – in the acute situation
give 24% oxygen if PaO2 <8kPa. Monitor ABG
and gradually increase oxygen concentration if
Pa CO2 is stable. In COPD patients, long-term
oxygen therapy (LTOT) for 15h/d increases
survival. Patients with chronic hypoxia when
clinically stable should be assessed for LTOT.

11. • Treat cardiac failure with diuretics such as
frusemide (=furosemide, e.g. 40-160mg/24h
PO). Monitor U&E and give amiloride or
potassium supplements if necessary.
Alternative: spironolactone.
• Consider vensection if the haematocrit is > 55%.
• Consider heart-lung transplantation in young
patients.
Prognosis
Poor 50% die within 5yrs.